Pericardial tamponade

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  •  Location: Emergency room
  • Pericardial Tamponade
  • Order 1:
  • IV access
  • Pulse oxy, stat
  • Oxygen, inhalation
  • Order general, lungs, and heart exam
  • Results:
  • Order 2:
  • IV NS bolus, and continue at 150 cc/hr
  • Elevate the patient legs
  • Continuous cardiac monitoring
  • Pericardiocentesis, stat
  • Results:
  • Order 2:
  • Stat EKG, 12 lead
  • Chest -X ray, portable
  • Transthoracic Echocardiogram (TTE), stat
  • Pericardial fluid for cell count, stat
  • ABG, stat
  • CVTS (Cardiovascular thoracic surgeon) consult, stat
  • Results:
  • Order 3:
  • Shift the patient to ICU
  • Continue continuous cardiac monitoring
  • Swan-Ganz catheter, stat
  • Diet - NPO
  • Complete bed rest
  • Place a Foley catheter
  • Urine output Q 2 hours
  • Pneumatic compressions of the legs
  • CBC with diff, stat
  • Basic metabolic panel, stat
  • PT/aPTT, stat
  • Continue NS @ 150 cc/hr
  • Gastric prophylaxis - Omeprazole (20mg) orally, once daily
  • Type and screen for 2 units of blood
  • Acetaminophen + codeine for pain, continuous (actually as needed in real life)
  • Next day order 4:
  • D/C Foley catheter
  • Repeat TTE
  • Repeat Chest -X-ray

Dr. Soryal, George